Rapamycin for refractory discoid lupus erythematosus.

Generalized discoid lupus erythematosus can pose a therapeutic challenge for dermatologists. Current treatment emphasizes photoprotection, topical and systemic steroids, and steroid-sparing immunosuppressive agents if necessary. Rapamycin, also known as sirolimus, selectively inhibits mammalian target of rapamycin, a regulatory kinase responsible for multiple signal transduction pathways.

An atypical syphilis presentation.

We present a case of lichenoid secondary syphilis in the genital area in the absence of other cutaneous or systemic manifestations. The patient did not experience an eruption on the palmar or plantar surfaces, which is rare. This case also is unique because of the intense pruritus associated with the genital lesions, a remarkable dissimilarity from typical secondary syphilitic eruptions that tend to be asymptomatic.

A case of self-healing juvenile cutaneous mucinosis.

Importance: Self-healing juvenile cutaneous mucinosis is a very rare, self-limiting disease characterized by the abrupt onset of asymptomatic papules and nodules located primarily on the face and periarticular regions of a juvenile patient. There have been less than 20 cases reported since it was first described in 1973.

Observations: Most cases have been reported in children 15 years and younger.

Purpuric eruption in a transfused neonate receiving phototherapy.

We describe the clinical and biochemical findings in a neonate requiring multiple blood transfusions and phototherapy for alloimmune hemolytic anemia and unconjugated hyperbilirubinemia, respectively. In this newborn, a severe photosensitivity reaction developed and laboratory testing revealed elevated serum and urine porphyrins at the time of the eruption. The cause of the transient porphyrinemia was likely multifactorial.

Blastomycosis-like pyoderma: response to systemic retinoid therapy.

Blastomycosis-like pyoderma is a proliferative tissue response with multifactorial etiologies that may mimic other inflammatory and neoplastic skin disorders. It often occurs on sun damaged skin of immunocompromised patients. We report a case of blastomycosis-like pyoderma in a patient with underlying metastatic medullary carcinoma of the thyroid receiving treatment with sorafenib (a multikinase inhibitor).

Pyoderma gangrenosum masquerading as necrotizing fasciitis.

Necrotizing fasciitis is a fulminant advancing soft tissue infection characterized by widespread fascial necrosis, which can result in significant morbidity and even death. This condition requires prompt diagnosis and aggressive management with extensive surgical debridement and appropriate antibiotic coverage. Pyoderma gangrenosum, in contrast, is a noninfectious inflammatory condition of the skin that typically does not require surgical management.

Mycophenolate mofetil in dermatology.

Unlabelled: Mycophenolate mofetil (MMF) is the prodrug of mycophenolic acid (MPA), a medication used to treat psoriasis in the 1970s until side effects and the concern of carcinogenesis led to its discontinuation. The prodrug, MMF, emerged decades later in the transplant field. Dermatologists have since used MMF off-label to treat various inflammatory skin conditions, with most research concentrating on its use in psoriasis, autoimmune blistering disorders, dermatitides, and connective tissue disorders.

Malar rash caused by metal allergy in a patient with systemic lupus erythematosus.

Background: A 61-year-old woman with an 8-year history of systemic lupus erythematosus presented with a non-pruritic, erythematous, malar rash. Previously, she had tested positive for antinuclear antibody and autoantibodies to double-stranded DNA and Ro/SSA, and had an elevated erythrocyte sedimentation rate. She wore eyeglasses with metal frames and had recently gained weight, which caused the eyeglasses to have increased contact area with her face.

Cutaneous mastocytosis in a patient with primary Sjögren's syndrome.

Mast cells have been linked to rheumatoid arthritis (RA) and are essential to the pathogenesis of RA-like disease in a mouse model. We describe a 34-year-old woman who developed Sjögren's syndrome concurrently with telangiectasia macularis eruptiva perstans (TMEP), a rare form of cutaneous mastocytosis. The patient had sicca symptoms with an abnormal minor salivary gland biopsy and decreased salivary flow, peripheral neuropathy, an 80 pound weight loss, and a macular erythematous rash that exhibited superficial perivascular mast cell infiltrates on biopsy of lesional skin.